Quantum Energy Healing intake form and waaiver
  • Quantum Energy Healing waiver

    Please take your time to fill out this quick form that lets me know a little bit about you!
  • Date of Birth
     - -
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Do you have any pre-existing medical conditions?
  • Are you currently taking any medications or supplements?
  • Have you ever been diagnosed with any mental health conditions?
  • Have you ever been diagnosed with any mental health conditions?
  • Do you have any allergies or sensitivities?
  • Have you received any other forms of energy healing before?
  • Consent & Understanding

    I, the undersigned, understand and acknowledge the following:

    1. Quantum Energy Healing: I understand that Quantum Energy Healing involves working with subtle energies, including but not limited to bioenergetics, chakra balancing, and energy field clearing. I understand that this is not a substitute for medical diagnosis, treatment, or care.

    2. No Guarantees: I understand that no guarantees are made regarding specific outcomes or results from Quantum Energy Healing. Each individual’s experience and healing process is unique.

    3. Personal Responsibility: I acknowledge that I am fully responsible for my own health and well-being, and that this healing process is intended to assist in my wellness journey, not to replace any medical advice or treatment.

    4. Confidentiality: I understand that all information shared in this session will be kept confidential, except as required by law or with my express consent.

    5. No Medical Diagnosis: I understand that Quantum Energy Healing practitioners do not diagnose medical conditions or offer medical treatment, and that I am encouraged to consult a medical professional for any serious health concerns.

    6. Physical/Emotional Sensations: I understand that during or after energy healing sessions, I may experience physical, emotional, or mental shifts. I acknowledge that these changes are part of the healing process and agree to monitor my own well-being following the session.

    Signature

    By signing below, I acknowledge that I have read and understood the information in this form and consent to the Quantum Energy Healing session.

  • Date
     - -
  • Should be Empty: